Person‐centred care in the Indonesian health‐care system

Person‐centred care (PCC) is defined as the health‐care providers selecting and delivering interventions or treatments that are respectful of and responsive to the characteristics, needs, preferences and values of the individual person. This model of care puts the person at the centre of care delivery. The World Health Organization suggests that PCC is one of the essential dimensions of health care and as such is an important indicator of health‐care quality. However, how PCC is implemented differs between countries in response to local cultures, resources and consumer expectations of health care. This article discusses person‐centred care in the Indonesian health‐care system.     

Giant left‐sided inguinoscrotal hernia containing the cecum and appendix (giant left‐sided Amyand's hernia)

The present case involved a 62‐year‐old male with a large left‐sided inguinoscrotal hernia. A CT scan and a clinical examination led to a diagnosis of a giant left‐sided Amyand's hernia. The hernia was repaired using the ULTRAPRO Hernia System (UHS), and the patient exhibited an uneventful postoperative course.     

Electrical low‐frequency stimulation induces long‐term depression of sensory and affective components of pain in healthy man

Electrical low‐frequency stimulation (LFS) of nociceptive skin afferents reliably induces long‐term depression (LTD) of pain. Recent experiments have assessed the effects of LTD on pain perception by using a simple one‐dimensional rating scale. The psychophysical study investigated the impact of noxious LFS on the sensory and affective aspects of pain perception by multidimensional rating scales. In 20 healthy volunteers, nociceptive fibers of the left hand dorsum were electrically stimulated by a concentric electrode. Test stimulation series (15 stimuli each, 0.125Hz) were performed before (Pre) and after (Post) a conditioning LFS (1Hz, 20min) or no stimulation period (Control). Pain ratings concerning test stimulation and LFS were obtained by multidimensional assessment including Verbal rating scale of perceived stimulus intensity (VRS‐I) and unpleasantness (VRS‐U) and pain perception scale with sensory (SES‐S) and affective items (SES‐A). After the conditioning LFS, VRS‐I, VRS‐U, SES‐S, and SES‐A decreased as compared to Pre series and Control. During conditioning LFS, ratings decreased. Factor analysis of SES‐S revealed sole reduction of superficial sharp pain perception after conditioning LFS in contrast to Control experiment. Perception of deep rhythmic pain decreased over time. Deep constant pain and superficial heat pain were not affected. Electrical test stimulation via concentric electrode evokes sensory as well as affective pain perception. Both components decrease during noxious, conditioning LFS and remain depressed for at least one hour. Reduction of sharp pain points to Aδ fiber mediated LTD. These results stress the analgesic potency of LTD and its possible impact on future therapy in chronic pain.     

Two‐week test–retest reliability of the Polar® RS800CX™ to record heart rate variability

Recently, research has validated the use of Polar^® heart rate monitors as a tool to index heart rate variability (HRV). In the current investigation, we sought to evaluate the test–retest reliability of both time and frequency domain measures of HRV using the Polar^® RS800CX^?. Continuous HRV data were collected as 60 nominally healthy adults underwent a resting and orthostatic stress test. We evaluated reproducibility by means of the interclass correlation coefficient for absolute agreement and consistency, and the standard error of measurement. We found moderate reliable 2‐week test–retest reliability of HRV using the Polar^® RS800CX^?, results that are in line with previous studies that have validated the stability of HRV using other methods of measurement (e.g. electrocardiogram). Additionally, when examining different methods of spectral density estimation, we found that using the auto‐regressive transformation method provides the most stable indices of HRV. Taken together, our results suggest that the Polar^® RS800CX^? is not only a valid method to record HRV, but also a reliable one, particularly when using the auto‐regressive transformation method.     

First‐in‐human retrieval of chronically implanted Micra transcatheter pacing system

We report the first‐in‐human retrieval of a chronically implanted Micra transcatheter pacing system (TPS; Medtronic, Minneapolis, MN, USA). A 41‐year‐old woman suffering from third‐degree atrioventricular block was successfully implanted with a TPS in the low septum of the right ventricle. After 29 months, due to an increased electrical threshold and 100% pacing percentage, the device showed low battery voltage. Despite the long implant duration, the attempt of device retrieval using a snare loop inserted in the delivery system of a TPS was successful. In the same procedure, a new leadless pacemaker was implanted in the high right ventricular septum with optimal pacing threshold.     

Design and validation of a dynamic cell‐culture system for bone biology research and exogenous tissue‐engineering applications

Bone lacunocanalicular fluid flow ensures chemotransportation and provides a mechanical stimulus to cells. Traditional static cell‐culture methods are ill‐suited to study the intricacies of bone biology because they ignore the three‐dimensionality of meaningful cellular networks and the lacunocanalicular system; furthermore, reliance on diffusion alone for nutrient supply and waste product removal effectively limits scaffolds to 2–3 mm thickness. In this project, a flow‐perfusion system was custom‐designed to overcome these limitations: eight adaptable chambers housed cylindrical cell‐seeded scaffolds measuring 12 or 24 mm in diameter and 1–10 mm in thickness. The porous scaffolds were manufactured using a three‐dimensional (3D) periodic microprinting process and were composed of hydroxyapatite/tricalcium phosphate with variable thicknesses, strut sizes, pore sizes and structural configurations. A multi‐channel peristaltic pump drew medium from parallel reservoirs and perfused it through each scaffold at a programmable rate. Hermetically sealed valves permitted sampling or replacement of medium. A gas‐permeable membrane allowed for gas exchange. Tubing was selected to withstand continuous perfusion for > 2 months without leakage. Computational modelling was performed to assess the adequacy of oxygen supply and the range of fluid shear stress in the bioreactor–scaffold system, using 12 × 6 mm scaffolds, and these models suggested scaffold design modifications that improved oxygen delivery while enhancing physiological shear stress. This system may prove useful in studying complex 3D bone biology and in developing strategies for engineering thick 3D bone constructs. Copyright © 2013 John Wiley & Sons, Ltd.     

A comprehensive 4‐year survey of adverse drug reactions using a network‐based hospital system

What is known and Objective: Spontaneous Adverse Drug Reaction Reporting Systems (ADRRS) provide early warnings or ‘signals’ for adverse drug reactions (ADRs). Our aim was to survey reports of ADRs made through our teaching‐hospital‐based pharmacovigilance system to identify the drugs most commonly associated with allergies and the types of immunological reactions reported. Methods: Adverse drug reactions records were retrieved from our network‐based electronic notification system. Results and Discussion: Four hundred and seventy four reports of adverse drug effects were studied. 37·3% of the reactions were immune‐mediated drug hypersensitivity reactions. True drug hypersensitivity reactions involving IgE‐mediated drug allergies accounted for 15% of all reactions. Of the drug hypersensitivity reactions, more than half (67%) were morbilliform skin eruptions, whereas cases of urticaria accounted for 20%. Antibiotics (33% of cases) were the most commonly reported drug allergies, followed by non‐steroidal anti‐inflammatory drugs (13%) and anti‐epileptic agents (10%). What is new and Conclusions: A hospital‐based ADR reporting system can generate useful data. In our study, antibiotics accounted for the majority of drug allergies, particularly anaphylactic reactions. More cases of drug allergies were owing to cephalosporin allergies than penicillins. Anti‐epileptic agents caused most of the severe drug hypersensitivity syndromes.     

Traumatic sternal segment dislocation in a 3‐year‐old girl: Sonographic findings

Sternal fractures are uncommon in the pediatric population, and sternal segment dislocations are even rarer with only a few cases reported in the literature. Most cases are secondary to direct trauma to the chest, but nontraumatic dislocations have been reported. The diagnosis can be difficult to establish with standard radiographs, while CT is not desirable in the pediatric population due to the associated irradiation. Ultrasound (US) can be used as the first‐line modality to evaluate the sternum. We report the US findings associated with a case of traumatic sternal segment dislocation in a 3‐year‐old girl. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :45–49, 2017     

Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column—A prospective,multicenter, randomized,within‐patient and parallel‐group comparative study to evaluate efficacy and safety

Over the past few decades, several cardiac autoantibodies have been reported in sera from patients with dilated cardiomyopathy (DCM). Immunoadsorption (IA) therapy is one of the therapeutic tools to remove such autoantibodies. The objective of this study was to investigate functional effects of IA therapy using a tryptophan column in severe DCM patients. Of 49 patients enrolled, 44 were randomized from 10 sites in Japan. IA therapy was conducted in 40 patients with DCM (refractory to standard therapy for heart failure, New York Heart Association [NYHA] class III/IV, left ventricular ejection fraction [LVEF] <30%). Mean echocardiographic LVEF was significantly improved (23.8 ± 1.3% to 25.9 ± 1.3%, P = 0.0015). However, mean radionuclide LVEF over 3 months of IA therapy was not significantly improved (20.8 ± 1.1% to 21.9 ± 1%, P = 0.0605). The cardiothoracic ratio was also significantly decreased (P = 0.0010). NYHA functional class (P < 0.0001), subjective symptoms assessed by a quality of life questionnaire (P = 0.0022), maximum oxygen consumption (P = 0.0074), and 6‐minute walk distance (P = 0.0050) were improved after IA therapy. Subgroup analysis revealed improvement of echocardiographic LVEF in patients with higher baseline autoantibody scores but not in those with lower scores. IA therapy improved subjective symptoms and exercise capacity in patients with refractory heart failure resulting from DCM. Favorable effect on cardiac function was noted in patients with higher autoantibody scores. J. Clin. Apheresis 31:535–544, 2016. © 2015 Wiley Periodicals, Inc.     

Staphylococcus aureus‐induced complement activation promotes tissue factor‐mediated coagulation

Essentials

• Complement, Toll‐like receptors and coagulation cross‐talk in the process of thromboinflammation.
• This is explored in a unique human whole‐blood model of S. aureus bacteremia.
• Coagulation is here shown as a downstream event of C5a‐induced tissue factor (TF) production.
• Combined inhibition of C5 and CD14 efficiently attenuated TF and coagulation.

Summary

Background

There is extensive cross‐talk between the complement system, the Toll‐like receptors (TLRs), and hemostasis. Consumptive coagulopathy is a hallmark of sepsis, and is often mediated through increased tissue factor (TF) expression.

Objectives

To study the relative roles of complement, TLRs and TF in Staphylococcus aureus‐induced coagulation.

Methods

Lepirudin‐anticoagulated human whole blood was incubated with the three S. aureus strains Cowan, Wood, and Newman. C3 was inhibited with compstatin, C5 with eculizumab, C5a receptor 1 (C5aR1) and activated factor XII with peptide inhibitors, CD14, TLR2 and TF with neutralizing antibodies, and TLR4 with eritoran. Complement activation was measured by ELISA. Coagulation was measured according to prothrombin fragment 1 + 2 (PTF_{1 + 2}) determined with ELISA, and TF mRNA, monocyte surface expression and functional activity were measured with quantitative PCR, flow cytometry, and ELISA, respectively.

Results

All three strains generated substantial and statistically significant amounts of C5a, terminal complement complex, PTF_{1 + 2}, and TF mRNA, and showed substantial TF surface expression on monocytes and TF functional activity. Inhibition of C5 cleavage most efficiently and significantly inhibited all six markers in strains Cowan and Wood, and five markers in Newman. The effect of complement inhibition was shown to be completely dependent on C5aR1. The C5 blocking effect was equally potentiated when combined with blocking of CD14 or TLR2, but not TLR4. TF blocking significantly reduced PTF_{1 + 2} levels to baseline levels.

Conclusions

S. aureus‐induced coagulation in human whole blood was mainly attributable to C5a‐induced mRNA upregulation, monocyte TF expression, and plasma TF activity, thus underscoring complement as a key player in S. aureus‐induced coagulation.